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Addressing Perfectionism in Youth

Presented by Devora Scher, Psy.D

This 60-minute webinar aims to help parents and teachers support a child or teen with perfectionism that gets in the way, rather than enhances their daily life. Participants will learn to apply skills to help children reduce anxiety and impairment associated with maladaptive perfectionism. Participants will also obtain familiarity with empirically supported treatment protocols related to perfectionism concerns.

Devora Scher, Psy.D. joined Stress and Anxiety Services of NJ (SASNJ) as a postdoctoral fellow after completing her internship at Kennedy Krieger Institute/Johns Hopkins School of Medicine. Formerly a middle school teacher, she pursued her doctoral training at Rutgers University’s Graduate School of Applied and Professional Psychology (GSAPP). Dr. Scher’s practica experiences included a range of outpatient clinic settings including New York Presbyterian/Columbia University Medical Center, Queens Hospital Center, Kings County Hospital Center, and several public and private schools, where she delivered evidence-based interventions to youth and young adults with anxiety, OCD, tic, and mood disorders.

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1:33 The New Jersey Center for Tourette Syndrome and Associated Disorders, its directors and employees, assume no responsibility for the accuracy, completeness, objectivity, or usefulness of the information presented. Nor do we endorse any recommendation or opinion made by any member or physician, nor do we advocate for any treatment. 1:52 You are responsible for your medical decisions. 1:56 Tonight, we’re welcoming doctorDevora Scher. This is first time. Doctor Scher has presented for NJCTS, but she brings with her enthusiasm for her talk, and a wealth of knowledge. 2:10 She joined the Stress and Anxiety Services of New Jersey as a postdoctoral fellow after completing her internship at Kennedy Krieger Institute, Johns Hopkins School of Medicine. 2:26 Schoolteacher, good luck on that one. She pursued her doctor doctoral training at Rutgers University and graduate School of applied and professional Psychology. Doctor … practice experiences include a range of outpatient clinic settings, including New York Presbyterian Columbia University, Medical Center, Queen’s Hospital Center Kings, County Hospital Center, and several public and private schools, where she delivered evidence based interventions for youth and young adults with anxiety, OCD, Ticks, mood disorders, and the mood disorders. Welcome, doctor Scher, we look forward to your presentation. 3:16 An extra Thank you to Kelley because she will be manning the tech component here, which is not co-operating too well, on my end. 3:26 Thank you, everyone, for joining this evening. As a big thank you to …. They do such wonderful work, and I’m honored to present with them tonight. And we will talk about perfectionist in youth. 3:39 And I understand that there’s the audience just rages in terms of caregivers, educators, and other disciplines, So hopefully example as well and recommendations will cover whatever your role. 3:52 OK, so, like many of you pick, next slide, please, like many of us here tonight, I have high standards for myself and for my performance. And as I was developing this presentation, I noticed urges to add more content, make changes, and more recently to rehearse. 4:09 And I mindfully chose to relinquish those expectations because it would have contributed to a great deal of stress, and, uh, other not so fun components. So, instead, I’m choosing to hopefully give worthwhile and formative and imperfect presentation. 4:28 Let’s continue. 4:32 So, part of my training in perfectionism comes from doctor Alice Color as author, Kagan’s author, Jonathan Grace, and a host of often OCD experts And we’ll talk about why OCD later and zoster allied toddler the starts one of his talks. 4:50 Let’s quote from Stephen Wright. In school, they told me practice makes perfect, and they told me nobody’s perfect. So then I stopped practicing. And this really begs the question, so we want to convey that practice makes perfect. A free is a quote that so often we’ve heard or two we want to convey May the practice makes better or practice makes permanent, perhaps. 5:12 So, tonight’s agenda, and, I guess is twofold. one, I want to really explore common manifestations of adaptive, maladaptive, perfectionist stick behaviors than youth and then we’ll discuss skills, What to do, Make an action plan. I’m someone who’s pretty practical. 5:31 I want you to come away with at least four overarching skills for how to really help when perfectionism reaches that maladaptive level. 5:45 I want to give a range of examples in terms of just like how we know what perfectionist perfectionist behavior looks like. 5:54 And, as I go through examples, think about which resonates with you. What you’ve observed. 6:02 Let’s start. So, your 16 year olds appear so frustrated with himself after receiving a 90% on an exam. So after receiving an imperfect mark, even though it’s so close to that hundred, that students often might feel like a failure, if they’re experiencing perfectionist concerns, are the next door, an astronaut being invited to enter the soccer fields first. 6:27 That nine year old child feels like she’s lost, because she’s out first, and perhaps even wonders, whether the coach is upset with her, or have a high school student procrastinating and avoiding yet another big assignment. We find that procrastination is often a key hallmark of perfectionist behavior. 6:48 And oftentimes, it’s a, it’s a result of beliefs, like, aye. 6:54 It’s, it’s just really overwhelming to start an assignment if you believe that you need to get a certain, you need to reach that certain level of performance. 7:04 Oftentimes, perfections are often over, studying over rehearsed, say, checking their e-mails, or checking the writing the contents of their e-mails to ensure just no error. And similarly, the next example, right? So a 12 year old is obsessing over a mistake. So there is a small are, just like maybe a small typo on one of our e-mails, that this 12 year olds is criticizing him soften, dismissing all comments about his job well done. 7:32 Oftentimes, perfectionists are asking, for a lot of reassurance, Is this correct? Is this right, Is this safe? 7:40 So, teachers out there might hear that a lot. Can you check this? Your seven year old next example engages in frequent erasing and rewriting. I need my handwriting, I need my notes to be a certain way. 7:54 The next is often surprising to people, What do you mean? My child’s room is so messy? How could he or she be a perfectionist like this? And often, we find that. 8:06 Because of the pressure to maintain the temperature, the pressure to maintain that room is just so overwhelming, that sometimes it’s just easier to get by that day with the hope of, of, being clean, rather than having to clean up, or similar, but a little bit different. 8:27 Like maintaining that. 8:28 Even if I could achieve this right now, even if I could achieve my room, being a certain way right now, I can’t, I will. It won’t be able to last forever, and that’s just really threatening for a person. 8:41 And last example here. Your senior in high school is demonstrating difficulty making decisions. Difficulty committing to college plans. 8:49 Oftentimes, perfectionist feel like, I need as much information as I can about this specific decision. 8:56 I need I mean, similar, of course, college is very different than what to buy in a store, but similar decision making skills, and oftentimes professionals that they’re in a store. I don’t know what’s a bad. I can’t decide I don’t have enough information. 9:12 I need more that I get oftentimes comes along with that reassurance. is this right? Is this what I’m supposed to be doing? Quote, unquote? Who knows what’s supposed to? But we’ll talk about that. So what all of these examples, hopefully highlighted, was that one profession is don’t believe are think they’re perfect. 9:29 If anything, the opposite, they feel like they can’t reach that level often. They’re not perfect stylistic, necessarily about everything and their behavior. 9:38 Does it necessarily look perfectionist? 9:44 It’s important to understand what beliefs are behind the perfectionist behavior. 9:49 And oftentimes, beliefs are related to whether or not they could handle this discomfort, the discomfort of not knowing what’s going to happen. 9:59 And let’s just look through these beliefs. 10:02 And we’ll talk more about the heart of the anxiety here. 10:07 If you aren’t first your last, so think about just that example with that child on the soccer field, they got picked sechin, but they feel like they’re not the best for me, if things aren’t right. 10:18 If they’re not perfect, even minor mistakes, feel to some people, like a job isn’t complete. 10:24 I need to have perfect understanding of this topic in order, and things should be a perfect according to my own standards. In order to be a worthwhile person, I must be perfect at everything I do, in order to speak. I need my words perfectly crafted, and if I have that belief, I will not be able to speak about this tonight, because my words are not perfectly crafted. I’m stumbling outside. 10:47 I must keep working at something until it’s done exactly right. 10:51 For me, I’m making a mistake is as bad as failing completely. 10:54 I must be the best at things that are important to me. 10:57 And lastly, here, if I can’t do something perfectly, I shouldn’t do it at all. 11:02 And let’s emphasize that these beliefs aren’t necessarily true, and we’re not looking to just demonstrate how accurate they are. 11:12 It is, however, important to understand what is this belief, whether it’s rational or irrational? 11:20 So here’s the broad definition of perfection as a multi dimensional personality dispossession characterized by striving for flawless ness and setting exceedingly high standards of performance. 11:32 And you’ll notice in this definition, it’s pretty neutral. 11:36 It doesn’t commit to being adaptive or maladaptive here. 11:41 And we see that at times, Perfectionist Strivings are ones are …, next slide, please. 11:48 And they are wonderful at times, It’s exciting to give to get that 100 on the exam. It’s exciting to get that attention, to get that recognition being first or winning that game. 12:01 And I really want to emphasize that at times part, I mean, the reason why we continue with trying to strive for that belief is because it’s exciting, It’s rewarding, It feels good. And when a person is productive, great, wonderful. If a person’s meeting their standards, that’s really great. 12:22 And oftentimes the perfectionist strivings do come at a great cost, and that’s why the next definition that I’ll highlight here focuses more on the maladaptive element. 12:33 The setting of and striving to meet very demanding standards that are self imposed, and relentlessly pursued. Despite this causing problems. It involves basing oneself worth almost exclusively on how well these standards are pursued, and achieved. And, you know, you’ll notice here, like I said, this is more of this is Kathy, Laura and Sue, the maladaptive components of the perfectionism. 12:59 From here, I will use the word perfectionism to refer to the maladaptive components while recognizing that if there aren’t, I guess if there isn’t impairment, if there aren’t great consequences, great negative consequences, then I’ll emphasize that and at, I’m, in most, I imagine most of you are here because perfectionist. 13:24 The perfectionism is coming at a cost, so is perfectionism A diagnosis? The simple answer is, no, perfectionism is not a diagnosis as an isolated construct whether or not it should be a different discussion. 13:39 We do, though, often see it as part of an obsessive compulsive disorder presentation. And I wanna just take a minute to describe what OCD is and what it’s not. 13:48 Oftentimes people associate OCD as hands wash and contamination. And really, it’s more than that. 13:56 OCD is about is about thoughts and urges that are stuck in a person’s minds and really just terrifying. It comes in different themes. So contamination is a theme, and there’s more than that. So, there’s a theme of OCD cause. the, not just right or the just right OCD and that really taps into perfectionist concerns where it feels like it just these. There are these very severe thoughts on urges that concept person’s mind. 14:26 Telling them almost it has to be a certain way or L and those obsessions, those are the intrusive thoughts, will, will really try to have a person perform what we call compulsive behavior or rituals. 14:40 And we will talk more about this later, but I want to emphasize that professionalism is not a diagnosis, and we, too, often see it correlated, with other forms of mental health diagnoses specifically OCD. 14:54 Let’s continue. 14:57 So in addition to OCD, there’s a perfectionist concerns. So the maladaptive forms of perfectionism correlate with other anxiety disorders, like panic disorder, generalized, anxiety, disorder, social anxiety, other types of disorders, like Body dysmorphic, disorder, depression eating disorders. 15:15 In addition to medical conditions, gastrointestinal disorders, migraines, and one explanation for just why. And we know that perfectionist concerns are just really stressful for people. They often contribute to a lot of loss of sleep, loss of time fatigue. So it makes sense that a person wouldn’t be able to care for themselves. That stress is correlated with mental health disorders. 15:44 So, here’s another, I guess here is really about the perfectionist profile. 15:51 Perfectionist often are engaging in all or nothing thinking. Think about the beliefs that I shared with you a few slides ago. 15:57 If I don’t get 100, if I’m not in first place, it’s like I failed. 16:02 Perfectionists are often setting close to impossible goals. 16:06 Really high goals. 16:07 And if there’s a flaw, it really feels very, very threatening. 16:13 What’s very interesting about perfectionist are that they maintain their goals, despite their experience. So despite not being able to get that 100 get every question right, despite not being able to keep a room a certain way, they still have that goal for themselves often. 16:29 And if they’re fails, if they didn’t meet that goal, instead of being able to say, hey, maybe my goal was a little too high, a little overwhelming, they’re oftentimes attributing the failure to themselves being defective almost. There’s a flaw within me, There isn’t just inherently flawed, as opposed to, my goal is unrealistic. 16:55 So, they judge them, solve, oftentimes, for exclusively based on the outcome, and oftentimes, the process is neglected, so they’re studying their effort. A host of external factors are often just minimized. 17:09 And it’s important to understand that oftentimes, perfectionist are motivated by fear of the negative outcome, as opposed to other positive motivators. So, oftentimes, perfectionists are playing, not to lose. They’re not playing to win the game. 17:24 It’s almost like the worst thing in the world for them is losing that all their energy is they have this tunnel vision and they’re really focusing all their energy on not losing instead of other parts of the process. 17:36 Like having fun, like interacting with people What’s really, really interest? A research shows that standing higher goals, actually, it does not maximize performance. Yeah. 17:48 This is something that is so hard for a perfectionist or realize It’s actually It actually leads to burnout sometimes maybe the perfectionist is able to be satisfied with their performance, maybe sometimes they can achieve their goal, but consistent performance with close to impossible goals is just unrealistic forever. For anyone. It’s not possible, it leads to burnout. 18:12 And in fact, Misstates are essential to the learning process And that’s really hard for perfection to realize, Huh, the consequences? There are so many consequences. I do want to point out before even going through these consequences that it’s our job as a therapist. It’s my job as parents, educators, whatever Your role to almost subtly points out. The costs just like we’re doing now. 18:38 Subtly points out the costs of what it’s like to strive for this flawless nus. Oftentimes it’s interesting that oftentimes people don’t come to therapy with perfectionism being their primary complete. 18:51 Maybe a parent or a teacher would point that out to me. But oftentimes, that’s really not what they’re, they’re complaining about. 18:58 And a few reasons why. 19:01 Why not? 19:02 one reason is that it’s, sometimes their standards are being met. So sometimes, usually they’re not failing, They’re not getting terrible, agree as they’re just really disappointed with themselves. 19:13 So sometimes the self criticism as a primary complaint, that more, oftentimes the perfectionist child feels that their, their standards, their beliefs are appropriate. 19:24 And it feels irresponsible to relinquish their standard, their fear of failure often, or whatever their specific form of that fear of failure is. 19:35 It’s just terrifying that it’s, it feels irresponsible to let go of there. 19:43 of lists. And just a quick example. Let’s say I have an exam coming up, and I believe that in order to be properly prepared for the exam, I have to go through all the practice exams that my teacher, or put out, or that, if I’m in college or grad school level, all the practice exams in the books, I have to go through in order for me to feel prepared. 20:05 Because there’s always more, if someone would tell me, I did enough use it enough, you’re prepared, you’re smart, it doesn’t necessarily, it doesn’t feel so convincing to me, because I have that belief that I have to go through every day. 20:19 And what we find is that instead of arguing about the accuracy of the belief, instead of arguing with me, whether or not you believe you will do the same thing as me, or whether or not I’m prepared or not, we actually shift the focus to the usefulness of the belief. How is that working for you? 20:39 So instead of the accuracy, we’re taking a look at the usefulness. And that’s why I’m sharing this before the, looking at the consequences. Because we’re looking together at, how is that working for you, OK, so you have that belief that you want to, that, you feel you have to go through all the practice exams. 20:54 Is that working, and oftentimes, we find that, actually, like us, that, at higher goals does not lead to better performance, stronger performance. So, oftentimes, there are academic or occupational decline that we could points out, loss of time. I need more sleep. You could points out, you need more sleep before the exam. 21:15 We oftentimes, oftentimes off, also find that people, people as a reasoning, it’s really weaker when they have close to perfectionist or unrealistic goals. 21:28 It’s interesting. 21:29 There was this example a lot that doctor Jonathan agrees centered OCD Expert shared, this past year’s OCD conference and he was saying that in the automobile industry, they actually don’t want, when they’re developing a new automobile. 21:45 They’re actually, the companies are actually instructing the employees to make it 100 don’t create, and 100% perfect, don’t create a perfect car model. 21:56 And the obvious question is, why not? You don’t want the best car out there? 22:02 The, it’s explained that it’s just simply not worth that, It’s too costly for them. 22:08 And I thought, that was just an interesting example to share, because even where productivity is the goal, it’s not necessarily better to strive for perfect. 22:19 Of course, it, to, people are often more self critical, and their self esteem is often threatened when they have perfectionist Strivings. 22:28 And there’s, of course, an impact. There is more attention. 22:33 Sometimes there’s withdrawal from family or loved ones and there’s just a disconnect not only as a result of the time that it costs to pursue these goals, but oftentimes, there’s a disconnect because of the, because of the process of getting to the goals or trying to get to these goals. 22:52 So the goal here, and I’m noticing an imperfect slide over here with, with my title being a lot of cutoff and that’s OK. 23:00 So the goal here is how to really shift from perfectionist, from being a perfectionist, to what we would call a Pursuer of excellence. 23:10 And it’s very scary. Like I said, it feels irresponsible for a perfectionist to relinquish that. 23:17 And even just thinking about their all or nothing thinking patterns, suggesting an alternative is really tricky, because for them, it’s either all or nothing. 23:25 So it feels just, How can I, You’re telling me that it gives us off? But then, I’m going to fail. We’re really, we’re hoping to be able to, and, we’ll go through how, exactly, in the next part, but we’re hoping to suggest an alternative to suggest a non catastrophic alternative. 23:43 Let’s try for external instead, And we’re gonna points out that, no, you’re not able to meet these goals consistently, So, let’s try for an alternative, And instead, we’re going to suggest we’re, the goal will be to have the perfectionist commit to attainable goals, modify the goals based on experience, being able to judge themselves based on multiple criteria, and take a look, and to be able to appreciate or observe with curiosity, the process, and positive outcomes. 24:19 So, let’s turn to part two now, Anna. 24:25 This is really about the how, let’s make an action plan. 24:30 And as we shift to ways that you can support your children, or children that you’re working with with maladaptive perfectionist tendencies. I wanna start off by dispelling, a very common myth. 24:42 And this is a quote, and the next slide will show a quote by doctor Allee Leibowitz. He is. 24:51 He’s a brilliant Anxiety Specialist director. He’s the Director of the Program for Anxiety Disorders at the Yale School of Medicine. 25:01 And here, he writes this quote, The desire to help your children live, the best lives they can live and to overcome challenges they face is completely separate from the notion that you as a parent caused your child’s difficulties. And there are so many explanations for why these are separate notions. I mean, one explanation. It. 25:21 That’s a click once again, but I’m happy if people in the Q&A section water. 25:26 I want to ask for the one quick explanation is oftentimes When we’re working with a child with anxiety and there’s another sibling, usually not every child in the family are presents with the same type of anxiety. 25:43 Usually we actually find that there is lot more than 1 or 2, I mean, we know anxiety is usually one in five, around 20% 20 to 25% of the population, and we often find that. 25:58 In a family, it usually, it’s only affecting, or I should say it’s not affecting the whole family, and that was, that’s something to suggest that this, maybe there’s another variable, such as genetics or something else. 26:13 We often say correlation is not the same as causation just because there is the correlation between let’s say a parent with anxiety and a child that’s not a causal relationship, so, let’s remember this that eliminate the blame here as we’re understanding some recommendations. 26:34 So I want to review the basic model of anxiety and well, let’s just take a situation might look more confusing, or probably easier with a situation? 26:46 Let’s take a situation of a child with fear of heights approaching a Rollercoaster so as the child is approaching the roller coaster, his or her anxiety is intensifying. It’s climbing. 26:58 And you’ll notice that’s where it’s going up on the way I’ll call this the wave of anxiety So it’s going up up up then let me notice there’s a third point which here it’s called the panic peak. There’s a certain point whereas anxiety. 27:13 It’s just feels like it can’t get any worse It’s the peak of that experience and it’s at that moment where the child will have a choice Do I approach the roller coaster are two why retreat? Do I avoid an essentially at all examples and we’ll talk more about it it’s approach or avoid do I approach that fear or do I avoid it? 27:33 Let’s, for this purpose. For now, let’s say the child chooses to avoid it, it’s too scary. They feel it’s not the right time. They’re not in the mood. So, they’re going to avoid it. 27:44 And, a few things happen pretty quickly when the child voids that Rollercoaster. 27:52 What does the child’s learn? 27:55 First off, the child learns that I felt better. I felt this really great sense of relief. It felt good to turn around. I was feeling so uncomfortable on the line, and now I feel like so much better immediately. 28:09 And that’s what happened to notice the steep drop. It’s almost like it would reach here, the peak, and then there’s that steep drop, because it felt good quickly. 28:19 The child also learns that the reason why, or the child often faced the reason why that it felt good, is because I avoided it. If I wanted to have avoided a lot, I wouldn’t feel good. 28:32 And what’s interesting here is that this is, I mean, we could apply this to every situation. But let’s, I guess, for now, look at the, the alternative. 28:41 Let’s say the child’s were to approach it, the child would have learned a few things as well. If the child’s would have chose to, what we call, ride that wave of anxiety, experienced that discomfort when it’s at its peak. 28:53 They would have noticed a few things. one, the child might learn that anxiety doesn’t persist. It doesn’t last forever. I could handle something. 29:02 Even if it’s uncomfortable, I can ride this wave, the child also might learn, that their specific fear might not happen. And that, there’s a few way of thinking in terms of anxiety. But usually, I’m comfortable saying that with kids. But let’s say they were fearful of vomiting after the rollercoaster. 29:22 Not always, well, they Varma, the fear might happen, it’s possible, but not probable. 29:28 And then, just really most importantly, the child’s learning. I could handle the discomfort. 29:34 So let’s, we’re going to keep this model in mind as we understand what happens and how we can, how we can support a child with perfectionist tendencies. 29:44 And oftentimes, we find that asking really well, meaning people, you’re here, you want to help, but sometimes we contribute to the avoidance cycle, we can attribute to that avoidance, that allowing the child to turn around. I guess I didn’t really emphasize or say, at all, the longer term consequences of avoidance, which I’m sure all of you know. Is that the next time the child will be not rollercoaster aligned, there’ll be more likely to avoid because they’re feeling like. 30:17 It felt good last time and maybe I can handle that. Maybe that’s just too much for me right now. 30:22 And oftentimes we might contribute to that avoid us for several reasons. 30:29 We want to reduce the child’s distress in the moment. 30:31 The child looks uncomfortable, we don’t want the child’s and discomfort. So, we’ll try to rescue them, we’ll try to encourage. It’s fine, you don’t have to go on the roller coaster, and especially this example it’s benign, why do they have to like every ride them apart? And another reason, sometimes, we contribute to avoidance, is because, maybe, we worry that the child’s will spell, or get hurt. 30:51 If we don’t rescue them. At times, the child might be threatening to become disruptive. 30:59 And, lastly, and, very honestly, it’s uncomfortable for us, usually, I don’t know about you, but often uncomfortable, I’m anxious watching my daughter or child in discomfort. 31:12 Maybe we want to reduce our gilts or anxiety. 31:15 And majority of parents know that avoidance, and other forms of rescuing isn’t ideal. A majority of parents know that. 31:25 It’s probably not the best, way, long term to handle the situation, but in the moment, research shows that parents are describing just not really knowing of an alternative. 31:36 I want to also emphasize that reassurance DK is the form of what we call this avoidant behavior. 31:42 And we’ll talk more about reassurance in a later slide. But I want to emphasize that reassurance is also a form of this cycle, this avoidance cycle, because what essentially is happening here is the child is anxiety is peaking. I don’t know if I’m getting the question, right? I can’t handle this discomfort. I don’t know if I could handle this discomfort. And that not knowing is really the heart of the fear that uncertainty difficulty we call the difficulty tolerating the uncertainties. So, again, to backup, the child’s anxiety is building, They’re taking the test. 32:18 They don’t know if they’re getting that question right, their anxiety is reaching that peak. 32:22 And then the child is asking that teacher or educator for that reassurance, did I get it right? Can you do anything possible for me to feel better about my performance for me to not reach that level of uncertainty for me to just feel like I got it right for me to get that certainty? 32:40 And oftentimes, what we know is that reassurance face. The child’s feel better. Right? They’re feeling good, so there’s that immediate relief and long term. They might attribute the reason why I was able to handle that was because I got that reassurance. 32:55 So, I wanna touch upon exposure on response prevention therapy because this is the gold standard therapy for obsessive compulsive disorder and this is very similar to I mean, it really just adsorbed cells with a model of anxiety. 33:12 And so often perfectionism is rooted in OCD and even if it’s not OCD level, more mild form or a sub clinical level, The exposure unresponsive, response, prevention therapy, might the appropriate style. 33:27 So, I want to emphasize what this says and the idea here is that we want to, we want to encourage the riding the wave process. We want to expose the child to imperfection. 33:40 We want to help the child’s realize that I could hands-on not knowing whether or not. 33:46 I get that Mark. 33:47 Well, I could. I want my child to really practice feeling a little discomfort and safe, tolerable ways. 33:55 So I’ll be on the slide for a little bit while I just explained some examples of how the therapy process might look. I know this! this presentation isn’t necessarily geared to mental health professionals, I just wanted to touch upon us though and again. So the the goal event is to expose the client to the imperfection and though we want to perfect what we call the safety behaviors. We want to prevent the child from engaging in the rituals that are contributing to the avoidance, designing to reduce the fear. So it’s a very action oriented therapy. 34:29 We’re not talking a child out of a concern Instead of we’re doing what we call behavioral experiments to see what might happen if we do X, Y, and Z And the idea of it is we’re allowing the unconscious mind to catch up with the conscious by talking it to it with actions, not with words. So I’ll give some examples. Not all the examples will be irrelevant. Of course. And I want to emphasize that. 34:52 Examples would be thoughtfully chosen based on the specifics of the child’s fear. 34:58 Specifically, we want to look at the feared outcome. What the child is afraid will happen that consequence. 35:04 So, Chai some examples, what I did last week, I was just thinking off the top of my head I might be practicing sensing an imperfect e-mail, reviewing an e-mail only once before sending it. 35:17 I may be having parents and child prophetess are resisting the urge to provide the reassurance, or resisting the urge to seek the re-assure us. We’re going to be processing performing activities just incorrectly or not, right. 35:35 We’re on my end, I tried to resist urges to rehearse and as we’re if resisting and urges to difficult, we’re going to work just to work in a formal hierarchy and maybe they were going to first start with delaying that urge. May they were gonna make a messy? 35:51 Oregon to make they had a person’s hand chart, a messy and maybe there are oftentimes people are returning items from stores if it if they feel like it. There’s a, there’s a perceived flaw on the items. So maybe we’ll keep up. 36:05 So, it’s really about processing sitting with that. 36:08 Not just with that imperfect that not just right feeling. 36:13 So, let’s look at how you can help and I’ll divide it. 36:19 The process, I guess, like, there is going to be four overarching skills here, and some skills will overlap in terms of just the intention, the, the goal event, And that’s OK, because just different things will resonate with different people. 36:35 So next slide, please. 36:39 So the first step is we’re going to really want to express non-judgemental interest in understanding the child’s behavior. I want to really understand the child’s belief and the behavior I probably should have added belief here in a way that offers, again, the non-judgemental pia. So I’m observing it with curiosity because I care because I’m interested. And we’ll talk about, there are two ways to get there. We’ll talk about the lemur skills and the support statements. 37:09 Limor is an acronym. This was developed by doctor Alana Kagan. And, and LIBOR is an acronym just for how to, I guess it’s really more than one of these these four skills, which is fine. And we’re gonna first want to label the child’s anxious or perfectionist feeling unbelief. 37:29 And then once that’s established, we’re going to express empathy and compassion without rushing to compensate or minimize the child’s distress. So that’s where probably the peak of the model is. We’re going to want to say something. 37:44 Like, you look anxious as, I’m sorry, you feel that way, or if that feels run comes role, you’ll choose wording that works best for you. 37:53 And I will say that as you’re developing any new skill just like walking or riding a bike. I mean, it might feel awkward at first So you’ll develop what feels more comfortable and it’s OK if that feels a little funky. 38:07 So the next one, the M here, is model calm, non anxious behavior, model the behavior that you wish your childhood practice, because actions speak louder than words. 38:18 So, we’re not going to want to say something like, it looks like you’re uncomfortable as your pacing, looking at your clock for, whatever, let’s say, you’re running late for something, So you’re going to want to model whatever you want your child to process here. 38:34 Be mindful of your body language. 38:37 The next piece here is using your skills, and this is where we’ll talk about the pursuer of excellent skills that we’re gonna wanna gently prompt. 38:46 And lastly, it is about rewarding and rewarding can be praised. 38:51 It could be, it could be, of course, a tangible reward, but even praise is very reinforcing. 38:58 And, today, I just want you to be thinking about what you feel, even just now, in terms of this specific model, where you feel you’re stronger, and where you wish to develop more. 39:10 Before I introduce the supportive statements, I want to highlight that there are two common pitfalls in the context of anxious parents. 39:19 And there are the two pitfalls, this probably should have been applied, or when parents are just engaging in what we call a demanding parenting behavior. And the second is the protective behavior. 39:34 And the demands in nature is just an example of that, as you can push through that. Through that, there’s nothing to be scared of. 39:41 Just do it, that, that type of behavior we would carrots are characterized as more demanding, whereas the protective nature might be something like a child wants to stay home or avoid a big assignment. And the teacher or a parent might say, OK, that’s fine. I’ll call your teacher oriented, that deadline extension. Or, that’s, OK, skip it, stay home today. If you’re not feeling, I want you to feel better, I don’t want you to, I don’t want to see you as a stress. 40:04 So, that’s the, that’s the process of nature. 40:08 So the next skill, the supportive crafting supportive statements, which we will do now, really addresses those two parenting styles that we find are usually not helpful in the long run. 40:21 So support meat is made up of two ingredients. Acceptance and confidence. 40:27 And we want to convey acceptance and confidence here because we want the child to really feel like we understand their experiences. Because if a child doesn’t sense, that you understand their experiences. 40:40 And of course, this is Eva. This is hard because it’s an internal experience. It’s a, it’s a thought, usually it’s a feeling that’s hard to pinpoint, which is why it’s even more important to demonstrate that understand they make it as if a child doesn’t sense that you get them. 40:55 They’ll be much more skeptical of your recommendations, and they’re charlestown, of course, your relationship with them is that much stronger When an acceptance dance is. 41:05 Is there an acceptance as the idea of It makes sense that you’re scared. Your experience is understandable to me. 41:12 I get it And The next point is the next ingredient here is the competence. 41:18 And confidence, it’s really about your belief in their abilities, So it’s a great first step to demonstrate to a child that they’re allowed to have the feelings, their feelings there, that you’re able to sit and handle their feelings with them without falling apart. 41:36 The next ingredient, the confidence is really important, because you’re gonna wanna gently prompt the use of the pursuer of excellent skills. You want to be able to empower them. And again, it’s OK if it feels fake or awkward at first. I want to point out, I will go through some examples where we’ll understand which ones are supportive. And, again, support is made up of both of these ingredients. But before we go that, I want to emphasize support. 42:02 Never feels demanding, support never feels forceful, just think about just, sometimes, the parallel with a medical situation is, Unfortunately, very helpful for us. 42:13 Think about what you would say to a child, with a sprained Ankle, would you say all children can can? Ron, why can’t you would, it feel that forceful? 42:22 Probably not. And just sometimes it’s just so much harder with mental health, where we feel like it’s not external. It’s not necessarily right in front of us. So let’s go through some examples. 42:34 Tran. 42:35 So just due to time, I’m not going to read all of that. But I want you to just take a look through them. You just have to power through. You’re fine. You can’t be thinking about this right now, it’s hard and you can do it. 42:49 I get it. It’s not easy for everyone. 42:52 Let’s go to the next slide, get into the time. 42:54 And I want you to notice that some of these were neither, neither contains acceptance or confidence, but what was containing both was, though, it’s hard, ads, you can do it. 43:08 Let’s continue. 43:11 So, similarly to how I identify the consequences of the child’s concern, the impairment, I want you to feel comfortable pointing out. 43:20 And again, this is about not evaluating the accuracy, whether or not you would engage in the same behavior, but rather the consequences. How is that working? 43:30 And then the next part, Step three here, is really about prompting these skills. How can we decrease all or nothing thinking? How can we modify the child’s goals? 43:41 How can we elicit other motivators, not just the playing, not to lose? 43:48 And reassurance seeking we will talk more about working to try to replace thoughtless support and reducing procrastination. 43:55 We’re instead of going to want to modify goal’s ads, perhaps use time limits, timer’s, out, of course, reward chart’s if appropriate. 44:07 We’ll talk more about some of them and I’ll give some examples now. Zoster alec Pollard’s deserves credit for this phrase, the perfectionist Proclamation and the perfectionist proclamation refers to what we frequently hear. I couldn’t stop. I couldn’t start this task, but next time, I will, I’ll do it next time. And so, often, we hear that. 44:26 I wonder, is that failure to do something? So often, right? The perfectionist is, right. It’s just like pleading. I’m going to do it next time. 44:34 I’ll do it now and they’re not often times able to recognize that it was due to their stance, their highest gathered on rather attributed to a host of external factors. 44:45 So we are not going to accept the Perfectionist Proclamation and a Therapy session. We don’t, except that, instead, we say, oh, there’s failure to do something, So let’s modify the goal together, because you were unable to do it, and because you’ve committed to it. 45:02 And let’s look at an example here, of how to modify a goal. So, we’re going to see linear, a process of writing an assignment. 45:10 Something that oftentimes is very overwhelming for, do you know, some people in general? 45:14 So, I will just give an example for how we’ll just elaborate on the first step. The left, the subtests, we’re gonna wanna as descriptive as possible. So it might be something like, I might give instructions to a child’s like this. 45:30 You’ll have 10 minutes to select the subject answering the next 10 minutes, You can review your, unless you can conduct brief research, you can ask other people for input. 45:40 You can look at your notes, this heads up that I gave you, and I want you to write down all the ideas that comes to your mind on this piece of paper, without judging them, anything that comes into your minds. 45:51 You’ll generate this list And by the time, the Alarms Downs, you’ll select something here and you’ll commit to writing a paper on this subject. 45:59 And if you don’t circle, any of them within the timer is off, that you’re gonna do it on the first one, that code that you wrote. 46:10 The goal here is we want to, we want to model, we want to encourage the good enough. It might not be the perfect, but we’re not going to allow for that hour or those that day, these long period of checking for, or trying to select that perfect subject. 46:26 So the other, I’m not gonna just give details for 2 to 6, but just an example, You’re the goal here, right? As reasonable editing, you want to be able to sit with that discomfort of, hands again, a good enough assignment. 46:41 Next slide. 46:44 The Pursuer of Excellence Girls that that we want to just encourage is really all of it’s about the next slide please appreciate a curiosity stance, appreciating the work in progress. 47:00 During the game, we want to be able to encourage the social aspects, not just the winning or losing during the learning process, we want to encourage the learning, the making mistakes. 47:12 We want to encourage people raising their hands, contributing in class, getting an imperfect answer, not having that perfectly crafted statement. 47:22 Has the next slide depicts just an example of a perfectionist types chart that I might use, and you’ll see what worse differ. 47:31 Obviously, it wouldn’t work for everyone, but there are ways to just be able to reward kids like points, and maybe you’ll want to think about ways to reward behavior that you want to see, so making things nasty. It might be a way to earn points here. Completing assignments because procrastination is such a key hallmark to perfection, as resisting reassurance might deserve some rewards. You think about this. That’s appropriate. I’m happy to send the speeds. 47:56 Yeah, the last of the four skills is agreeing with the fear. 48:02 And this skill is about responding to reassurance seeking behaviors. 48:07 Definitely. So if a child is asking, is this correct, I might just simply say, I don’t know. 48:14 Because the goal here is helping the child’s realize that the feared outcome might occur despite our best efforts failing or whatever, the feared outcome It might happen even though we don’t want it to even though it feels uncomfortable even though, it feels almost intolerable. 48:30 And you can replace the reassurance seeking with support. So, an example of the supportive statement is the third here that I want to encourage you. It doesn’t have to be that lengthy I just included at. And I included that along with shorter, more concise responses. 48:46 But an example of a support of state law would be something like, I know I see that the feeling of not knowing what you got on the test or the feeling of not knowing if this is correct or not is so uncomfortable, I’m confident in your abilities to pick an answer to make a decision with the information that you have with whatever you came in. That’s asked, Why. 49:06 Other examples of how to respond to reassurance questioning reassurance seeking is just simply we’ll see, I’m not sure, why should you trust me? I mean, we’re not going to say that, but that’s the idea. Why would you know better than that, necessarily? We want them to practice. 49:23 Tapping into, again, the heart of the anxiety. Is that uncertainty. I don’t know what will happen. I don’t have a better answer for you. 49:33 As I was developing these four steps, which will review that as I was, as I was just developing that. I wanted to be mindful of the all or nothing trap, that some audience members might be engaging in. Almost like, this is so much. 49:47 This is a past presentation in an hour and I don’t know what I’ll be able to take away from this. 49:54 It’s a lot and I want you to be mindful. 49:57 If that’s occurring for you, I want you to be mindful of that and engage the parallel process. 50:03 So often that’s what perfectionist might engage and right? It’s just too much, I don’t know where to start, I’ll shut down now. 50:09 So, instead, what we do in a therapy session or just like, I want to encourage you to practice now is think about why you’re here. 50:18 Think about the reason’s tap into your motivation. 50:23 Is this a worthwhile investment? Yeah, it’s a new set of strategies, perhaps. It might require more effort. 50:28 It probably will as, Do I want to do this. How important is this for me? 50:36 Hands, essentially then come to, What can I take away? What aspects can I, can I do now? And what am I stronger at? Really reflecting on, that, giving yourself some self pride. 50:50 I love this quote doesn’t directly asked, but I thought I can include this: we must see the child as in trouble, not the cause of trouble. 50:58 Add: So, Often, it’s just so easy to: get frustrated, And we’re human, It’s not, always fun to watch a child suffer its lover funds so after child suffer, and sometimes it helps to just remember, the child’s is also in discomfort right now. 51:16 And let us review. So the four steps here. The first here is non-judgemental. The labeling, the perfectionist concern or believe. Think about the two slides where we went through a host of examples and then the beliefs. 51:32 We want to really understand what’s going through. The child’s internal, internal experiences. What’s going on internally for the child? Remember that the behavior might not look perfectionist and remembering that this is probably the place where we’ll use the first two lemur skills labeling, and expressing that compassion, or the supportive statements, except with them confidence, equal support. 51:52 The next is increasing motivation, not debating the belief. 51:56 Instead evaluating the usefulness of it, how is that working? What are the consequences here for striving for of striving for flawless test? Are the beliefs adaptive or maladaptive if they’re adaptive if the child’s behavior if their goals are being met. 52:11 Don’t address them, but if there are, if there is impairment associated with it, then we will want to likely encourage the pursuer of excellence skills, proper use of skills, and model that risk taking, model that good enough, setting, model setting, or reasonable goals. Be able to modify the goals based on experience like we talked about. 52:32 And then lastly is agreeing with the fear, reducing that reassurance, and instead feeling comfortable to say, I’m not sure I don’t have a good enough answer for you. I’m confident in your abilities because the feared outcome might happen, whether or not you provide that reassurance. 52:50 I don’t wanna just briefly show my references. I learned from a lot of people. These are most of today’s presentation and comes from the work of … and … Myers and doctor Pollard. 53:06 And I am happy to answer questions now. 53:13 OK, sorry, took me a minute, unmute myself. So, that was a wonderful presentation for, thank you very much. We do have a few questions out there, but I want to let the audience know that at 8 30, we’ll pause for about NaN. 53:35 You’re welcome to leave at that time, and you’re because we did commit to an hour, but the speaker will take questions after that. 53:51 Um, but we’ll pause at 8 30 and then and then restart the question and answer. 53:58 So, listening to students perseverate sounding like a stem or stutter or is it more the part of the OCD? 54:09 Or should she be evaluated for just fluent speech? 54:16 They also carry the diagnosis of autism and ADHD. 54:21 Yeah, who would be a little irresponsible if I made answer that definitively I would recommend an evaluation and it is definitely possible for OCD to come with that just that. Hesitation that I need that perfect thing to come out of my mouth But definitely I would recognize that evaluation. I’m not a speech language pathologist. 54:48 OK, fair enough, absolutely fair enough. 54:56 Again, people you’re, you’re putting, please feel free to put your questions in the question box and click send. We’ll be happy to answer them as they come in. 55:09 So earlier in the presentation you said sometimes the. 55:17 Here are the messy room could be. 55:25 Could be the or be a perfectionist you. Could you readdress that because I’m not, I didn’t quite understand how, how that could. 55:38 That’s? yeah, absolutely, and it is not always, the narrative is not me and it is not due to my perfectionist believes. So, what we sometimes find real ID, and it’s just really important, so I must ask that child’s, right? So why? Why aren’t you cleaning here when I’m asking you to. 55:59 And, but what we do sometimes by, is that the pressure to maintain a campus room is just a really overwhelming, that how can I start. I’m not going to be able to achieve that expectation. So, Similar, or Sometimes, studying is an easier parallel, But I wanted to provide a range of examples here, so think about, I can’t start, I’m going to procrastinate. I’m not going to begin that assignment, because I, I might fail, and I won’t be able to study well enough. I won’t be able to do well enough that I can’t start. It’s that same process. Again, it might not be the child who might not want to clean the room. 56:38 A simple litmus test that we sometimes do is, I mean, let’s try it. If it’s just laziness, or something also laziest a controversial word, I know. 56:50 Try it. Let’s do it right now. 56:53 See, I guess, what comes up for the child. 56:56 If I, if you, if you just ask Ana Aslan to elaborate on their internal experience. Specifically just their thoughts. 57:09 OK, you talked about supportive statements. 57:14 Yeah. 57:16 Can you help us? Or can you give some examples that teachers might use to motivate their students? 57:26 Hmm, hmm, hmm, Yeah, and I’m specifically doing it from an anxiety framework right now, So, motivation could, I mean, there’s a lot underlying motivation, but specifically if anxiety is the key problem behind the motivation, I might want to say something like: it makes sense that you’re scared about us. I get that, It’s hard, as I’m asking you to do it. 57:53 So, you could be as chancellor as firm as needed, but the idea here is acceptance, I understand that this is what’s going on for you. I understand. You don’t want to maybe, if I want to make it more broad, I understand this is difficult. 58:08 I understand that It’s not your choice, and I believe you can do it. 58:13 I believe that you could get through this. 58:16 I believe, that you could handle that. 58:20 Let’s say, crassly that confidence and the acceptance. 58:24 All right. 58:26 Can you speak to the overlap of perfectionism and social anxiety regarding asking questions or participating in class? 58:35 Yeah. We find that so often they’re co morbid. 58:40 The question is the little open answer. I’m happy to talk about the overlap. 58:48 Just, I have to de identify completely. Let’s say I tried to make it fictional over here. 58:55 So, a child with OCD, who is feeling that just right theme or that not just right theme is also let’s say, feeling like, I can’t participate because like, I think I might’ve share this example. 59:09 I’m embarrassed. What if my friends? And this is getting so social anxiety. What if my friends laugh at me, what if they reject me, based on my speech not being perfect over here? 59:20 Based on my making an error, I’ll say the wrong answer, I’ll make a little mistake, or I’ll make a big mistake, and they’ll reject me. I won’t be liked. 59:32 Is just an example, happy to elaborate if the questioner wants to follow up. 59:40 The time is 8 30, and we can, you know, those of you that need to go attend to other things, we are happy to have you. Please fill out the survey as you leave. If you want to, you’re welcome to stay on and doctor share will answer some more questions that we have. 1:00:06 Um, so, again, thank you for attending. 1:00:11 Yes. Thank you for joining. 1:00:13 And I’m happy to stay if there are more questions MR. 1:00:17 So let’s start off with this. 1:00:19 How does your approach change if the parent and the child are both perfectionists? 1:00:27 So it’s actually, that’s a great question, the approach does not change. And part of the lemur model, the you was use your skills. It’s so hard, but we’re going to encourage the parent to use whatever skills that they can. 1:00:43 If they need professional health, that’s OK. We might collaborate with a therapist, if needed. 1:00:51 We’re gonna look at the goal, and oftentimes we do find that. Perfectionist, professionals, behaviors, do run in families so the approach does not change. 1:01:02 We’re just going to be mindful of helping a parrot, hansel their discomfort and understands that the risk taking might be harder and it’s OK we believe that both the parent and child could experience success with this process. 1:01:22 I have an eight year old who cries hysterically if they don’t Hit a baseball, or if they don’t strike someone else out when they’re being picture. 1:01:34 And this seems to be A therapist asking this question mm hameed Yeah, Hi, I don’t hear the exact question to empathize. That’s a hard situation. 1:01:50 I would really encourage, if this is a therapist working on it, we’re going to exposure therapy together and we’re going to form a hierarchy and maybe we’re not going to use that example to start, but we’re gonna look at what we call the function of the fear, so what’s reinforcing the fear? What’s, what’s the feared outcome? Is the child afraid of the failure? 1:02:15 Perhaps the social component of being in front of the crowd, and we’re gonna find other ways to slowly and gradually attack and challenge that feared outcome and without necessarily starting without experience, if it’s if it’s historical cry. 1:02:35 OK, is it possible to notice perfectionism in the child as young as four years old, and how do you work with the child, the young? 1:02:48 Now, who doesn’t have the same kind of understanding as an older child? 1:02:52 Yeah, it’s very possible. It’s hard to know exactly their internal experience, namely their thoughts or their beliefs. 1:03:03 We still, though, can attack it a very similar way. 1:03:09 My young child, I was worried that we’re also going that direction today on an hour day and we practice just approaching that fear ads, maybe first you would do something like we call. the I do. We do then used to model where first I do it, I make that mistake Or the example. 1:03:31 The questionnaire incident, provider ASAP which is fine but maybe first I practice that imperfection and then we do it together then slowly we’ll watch the child do it. 1:03:43 So, perhaps rewards will be more helpful with with a child as young as four, and I want to offline courage. 1:03:52 Parents can be directive, unless that will add it. 1:03:55 If it’s an older teenager, or young adult, we might want to encourage more collaborative process, whereas younger, it will be more directive. 1:04:08 OK, Thank you. Sorry, I was also answer the question of how people can reach. You. can reach you through the Stress and Anxiety Services of New Jersey, and that is correct? Yeah, oh, that’s fine. 1:04:23 OK, and where you’re located in Union, currently, we have two locations were primarily Utilizing Telehealth. 1:04:32 Currently exclusively, where a process with a bunch of psychologists, though, there are some that are in person in East Brunswick and in Florham Park, New Jersey OK great, Thank you very much. 1:04:48 Yeah. 1:04:51 So, those are the end of the questions for the moment. So, I think we’ll end the webinar for this evening. I’d like to thank you for joining us for this webinar on Addressing perfectionism in youth. There is an exit survey, which we need everyone to attending to fill out. 1:05:14 The webinar blog is now open and available for the next seven days. On JSUT website, for any additional questions that we may not have gotten to, or that you’re just thinking about, how. That website is, www.njctsd.org. And an archived recording of tonight’s webinar will be posted to our website shortly. 1:05:44 Our next presentation, Medication Management of Tourette Syndrome and Co Record, Co-occurring Disorders, will be presented by doctor Heard, and is scheduled for May fourth, 2022. This ends tonight’s webinar. Thank you, Doctor, Scher for your presentation, and thank you everyone for attending. 1:06:07 Thank you, Good Night..

Comments(8)

  1. Reply
    Deena A. says:

    Can you speak to the overlap of perfectionism and social anxiety regarding asking questions or participating in class?

    • Reply
      Devora Scher, Psy.D. says:

      There is often an overlap between maladaptive perfectionism and social anxiety. Often times, people with social anxiety are concerned about rejection, and in response, they may try to avoid situations where they may feel embarrassed. It is really important to understand the individual’s specific fear. Are the worried about others’ reactions would they ask a “dumb” question? If such beliefs are apparent, they may try to mentally rehearse their question (I.e., trying to achieve “perfect communication”) or avoid asking it altogether if their anxiety feels intense.

    • Reply
      Devora Scher, Psy.D. says:

      Perfectionism is not a mental health diagnosis at present, so we can notice perfectionism tendencies at almost any age. It is important to understand the child’s beliefs, which might be difficult at younger ages. That said, the acceptance and behavioral skills outlined in the presentation are still recommended. With younger children, it can be helpful to utilize an “I do, we do, you do” model. The child can first observe a caregiver/therapist approaching the fear, next the child can engage in a collaborative process participating in the feared activity together with the caregiver/therapist, and finally, the child can be encouraged to approach the situation independently if appropriate. At times, when insight and motivation are weaker, tangible forms of reinforcement in addition to praise are useful.

  2. Reply
    Elizabeth BG says:

    I have an 8 year old client who cries hysterically if they do not get a hit in baseball of if they do not strike someone else out when being the pitcher. How would you encourage this child?

    • Reply
      Devora Scher, Psy.D. says:

      As explained in the webinar, it can be helpful to utilize supportive statements (conveying both acceptance of the child’s experiences in addition to confidence in their abilities). That said, without more information about the child’s specific fears, it is difficult to provide specific recommendations. With nonjudgemental curiosity and expressions of compassion, I would try to understand with the child what feels so threatening about not getting a hit or not striking someone else out when being the pitcher.

  3. Reply
    Pat P says:

    It is possible to notice perfectionism in a child as young as four years old? How do you work with a child that young that may not have the same understanding as an older child?

    • Reply
      Devora Scher, Psy.D. says:

      Perfectionism is not a mental health diagnosis at present, so we can notice perfectionism tendencies at almost any age. It is important to understand the child’s beliefs, which might be difficult at younger ages. That said, the acceptance and behavioral skills outlined in the presentation are still recommended. With younger children, it can be helpful to utilize an “I do, we do, you do” model. The child can first observe a caregiver/therapist approaching the fear, next the child can engage in a collaborative process participating in the feared activity together with the caregiver/therapist, and finally, the child can be encouraged to approach the situation independently if appropriate. At times, when insight and motivation are weaker, tangible forms of reinforcement in addition to praise are useful.

    • Reply
      Devora Scher, Psy.D. says:

      There is often an overlap between maladaptive perfectionism and social anxiety. Often times, people with social anxiety are concerned about rejection, and in response, they may try to avoid situations where they may feel embarrassed. It is really important to understand the individual’s specific fear. Are the worried about others’ reactions would they ask a “dumb” question? If such beliefs are apparent, they may try to mentally rehearse their question (I.e., trying to achieve “perfect communication”) or avoid asking it altogether if their anxiety feels intense.

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